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					<td width="90">姓名</td>
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					<td width="80">曾用名</td>
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					<td width="100">出生年月</td>
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					<td rowspan="3" width="50">相<p>片</P></td>
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					<td width="90">性别</td>
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					<td width="80">民族</td>
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					<td width="100">政治面貌</td>
					<td width="92"></td>
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					<td width="90">年龄</td>
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					<td width="80">籍贯</td>
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					<td width="100">身体状况</td>
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						<td rowspan="2" width="80">基本情况</td>
						<td width="70">毕业学校</td>
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						<td width="80">家庭住址</td>
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						<td rowspan="5" colspan="2" width="60">成<p>绩</p></td>
						<td colspan="2" width="90">第&nbsp;&nbsp;一<br>学&nbsp;&nbsp;期</br></td>
						<td colspan="2" width="82">第&nbsp;&nbsp;二<br>学&nbsp;&nbsp;期</br></td>
						<td colspan="2" width="82">第&nbsp;&nbsp;三<br>学&nbsp;&nbsp;期</br></td>
						<td colspan="2" width="82">第&nbsp;&nbsp;四<br>学&nbsp;&nbsp;期</br></td>
						<td colspan="2" width="82">第&nbsp;&nbsp;五<br>学&nbsp;&nbsp;期</br></td>
						<td colspan="2" width="82">第&nbsp;&nbsp;六<br>学&nbsp;&nbsp;期</br></td>
						<td colspan="2" width="82">毕&nbsp;&nbsp;业<br>设&nbsp;&nbsp;计</br></td>

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						<td rowspan="4" colspan="2">实<p>习</p></td>
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						<td colspan="3">何时何地受过<br>何种处罚</br></td>
						<td colspan="6"></td>
						<td colspan="4">何时何地受过何种奖励</td>
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						<td align="center">备<p>注</p></td>
						<td colspan="14">(1)一律用钢笔填写,字迹要端正、清除。<p>(2)内容要具体、真实。</p></td>
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